Ethical Considerations for Telepsychotherapy and the Management of High-Risk Patients During Coronavirus 2019 (COVID-19): Challenges and Practice Considerations

Exploring the Safety of a General Digital Mental Health Intervention to Effect Symptom Reduction among Individuals with and without Suicidal Ideation: A Secondary Analysis

Trials of digital mental health interventions (DMHIs) often exclude individuals with suicide-related thoughts and behaviors precluding an understanding of whether DMHIs for affective disorders are safe for, and perform similarly within, this high-risk group. We explore the safety and performance of a DMHI for depression in participants with and without suicidal ideation (SI) at baseline. Three hundred and one participants were included in this secondary data analysis from a trial of an 8-week DMHI comprising 14 smartphone apps. We found that SI decreased across the study among participants with baseline SI and that baseline SI status did not attenuate depression treatment effects. Through a case study of the IntelliCare platform, we find that DMHIs for general affective disorders can be safe.

Meaning and Experience of International Migration in Black African South African Families

This article explores the experiences of some Black South African families affected by international migration. Historically, emigration from South Africa has occurred in waves, and has been associated with specific political moments. Such migration has often been perceived as a predominantly "White phenomenon", but recent trends reveal a more complex picture. Prior research on Black migration has focused primarily on internal labour migration, exilic migration and the "brain drain" phenomenon of medical professionals. So far, little research has been done on the impact of international outward migration on the Black family system. This article addresses this gap, drawing on a larger qualitative project exploring the impact of South African emigration on elderly family members staying behind. The findings highlight the significance of close relational ties in the Black South African family system. Familial separation through emigration brings feelings of loss and apprehension for the wellbeing of family members living abroad, including potential racism in destination countries. Migrants abroad highlighted the value of family and of maintaining a Black South African identity, despite separation from the country of origin and the extended family. Significantly, migration is often perceived as a temporary state, in contrast to White South African counterparts. Given increased international migration, the results shed light on the interplay between racial identity and emigration, and the impact of international migration by Black South Africans on family that they leave behind.

Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights

Background

With adolescent depression and suicidality increasing, technology-based interventions may help address mental health needs. The Enhancing Treatment and Utilization for Depression and Emergent Suicidality (ETUDES) Center supports development of technology interventions to help primary care providers target these problems. To successfully develop and integrate such interventions into primary care, iterative engagement of stakeholders is necessary. This paper outlines our stakeholder engagement process, a qualitative analysis of feedback and outcomes, and how feedback was incorporated to develop Center interventions.

Methods

Stakeholder panels represented key end-users of ETUDES Center interventions (adolescents, young adults, parents, and healthcare providers) and their advocates at the organizational/policy level. Meetings were held throughout intervention development and at annual retreats. Detailed meeting notes were collected and summarized by the stakeholder engagement team in real time, after which action items were generated and reviewed by the full research team. Using a content analysis approach, all stakeholder feedback summaries were coded using a prespecified codebook organized by recurring topics. Codes were organized under the Consolidated Framework for Implementation Research (CFIR). Anonymous stakeholder feedback surveys assessed relevance of topics, meeting effectiveness, and stakeholder involvement.

Results

Stakeholder meetings provided feedback on topics such as representation, language, access to care, and stigma. Relevant feedback and recommendations were incorporated into subsequent iterations of the interventions and their implementation. Mean stakeholder ratings of meeting proceedings on a 0–3 Likert scale ranged from 1.70 ( SD  =  0.10) for participation to 2.43 ( SD  =  0.08) for effectiveness in addressing meeting agenda.

Conclusions

The iterative engagement approach yielded practical feedback from stakeholders about ETUDES Center interventions. The team organized feedback to identify barriers and facilitators to using Center interventions and to generate action items, which were transposed onto components of an implementation strategy, supplemented by the CFIR-ERIC Implementation Strategy Matching Tool. Stakeholder feedback will direct the future development of an integrated intervention and guide further stakeholder engagement in developing technologies for adolescent mental health. Plain Language Summary: Depression and suicide in teens have been on the rise for the past several years. Primary care may be an ideal place to address these concerns because most teens have a primary care provider (PCP) who can offer a confidential place for both teens and their caregivers. Our Center develops technology-based interventions to help PCPs address teen depression and suicidality. Multiple barriers may hinder PCPs in addressing teen depression and suicidality. This paper describes how we engaged multiple types of stakeholders—or individuals with an interest in adolescent mental health—to ask for their feedback over a series of meetings, to help us improve the fit of our interventions to this population. Stakeholders included providers, community members like parents and mental health advocates, youth, and policymakers. We learned what was most important to them—including concerns about equitable access (e.g., providing broadband internet to families who do not have it so they can still participate) and legal risks or failures for the technology to identify suicidality. In this paper, we describe our process for not only recruiting and engaging stakeholders but also for planning action based on their feedback. Similar processes could be used by other researchers and clinical organizations seeking to incorporate technology into mental health interventions.